Dataset Information

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis.

ABSTRACT:

Importance

Limited guidance exists regarding the optimal approach to management of pain in acute pancreatitis (AP).

Objectives

To investigate sources of variability in opioid use for treatment of acute pain in patients hospitalized for AP and to explore a potential association of opioid prescribing patterns with length of stay.

Design, setting, and participants

This retrospective cohort study included 4307 patients 18 years and older hospitalized for AP in a community-based integrated health care system, from January 1, 2008, to June 30, 2015. Analysis began in November 2017.

Exposures

Opioid use was quantified by morphine equivalent dose (MED).

Main outcomes and measures

Three analyses were performed: (1) factors associated with increased opioid administration during the initial 12 hours of hospitalization (baseline), (2) association of baseline opioid use with length of stay, and (3) frequency of opioid use 90 days after hospital discharge (persistent use).

Results

The cohort included 4307 patients (median [interquartile range] age, 57.4 [44.0-70.2] years; 2241 women [52.0%]) with AP. At baseline, 3443 patients (79.9%) received opioids, and 388 patients (9.6%) had persistent opioid use after discharge. After adjusting for pain and other clinical factors, women received less MED than men (adjusted event ratio, 0.83; 95% CI, 0.79-0.86; P?Conclusions and relevanceIn addition to pain and disease severity, opioid use varied by etiology of AP, sex, race/ethnicity, and institution of treatment. Increased opioid use at baseline was associated with longer hospitalization. These findings suggest opportunities for improved approaches to pain control for patients with AP.

SUBMITTER: Wu BU

PROVIDER: S-EPMC6481601 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis.

Wu Bechien U BU Butler Rebecca K RK Chen Wansu W

JAMA network open 20190405 4

<h4>Importance</h4>Limited guidance exists regarding the optimal approach to management of pain in acute pancreatitis (AP).<h4>Objectives</h4>To investigate sources of variability in opioid use for treatment of acute pain in patients hospitalized for AP and to explore a potential association of opioid prescribing patterns with length of stay.<h4>Design, setting, and participants</h4>This retrospective cohort study included 4307 patients 18 years and older hospitalized for AP in a community-based ...[more]

PMID: 30977846

Similar Datasets

Project description:BACKGROUND:Opioids are commonly prescribed in the hospital; yet, little is known about which patients will progress to chronic opioid therapy (COT) following discharge. We defined COT as receipt of ??90-day supply of opioids with <?30-day gap in supply over a 180-day period or receipt of ??10 opioid prescriptions over 1 year. Predictive tools to identify hospitalized patients at risk for future chronic opioid use could have clinical utility to improve pain management strategies and patient education during hospitalization and discharge. OBJECTIVE:The objective of this study was to identify a parsimonious statistical model for predicting future COT among hospitalized patients not on COT before hospitalization. DESIGN:Retrospective analysis electronic health record (EHR) data from 2008 to 2014 using logistic regression. PATIENTS:Hospitalized patients at an urban, safety net hospital. MAIN MEASUREMENTS:Independent variables included medical and mental health diagnoses, substance and tobacco use disorder, chronic or acute pain, surgical intervention during hospitalization, past year receipt of opioid or non-opioid analgesics or benzodiazepines, opioid receipt at hospital discharge, milligrams of morphine equivalents prescribed per hospital day, and others. KEY RESULTS:Model prediction performance was estimated using area under the receiver operator curve, accuracy, sensitivity, and specificity. A model with 13 covariates was chosen using stepwise logistic regression on a randomly down-sampled subset of the data. Sensitivity and specificity were optimized using the Youden's index. This model predicted correctly COT in 79% of the patients and no COT correctly in 78% of the patients. CONCLUSIONS:Our model accessed EHR data to predict 79% of the future COT among hospitalized patients. Application of such a predictive model within the EHR could identify patients at high risk for future chronic opioid use to allow clinicians to provide early patient education about pain management strategies and, when able, to wean opioids prior to discharge while incorporating alternative therapies for pain into discharge planning.

Project description:Study designSerial cross-sectional study utilizing the National Inpatient Sample (NIS) 2005 to 2014.ObjectiveThe aim of this study was to examine the trends of opioid-use disorders among hospitalized patients with spinal conditions and treatment and to identify its contributing factors.Summary of background dataThe opioid is widely used in chronic spinal conditions, and misuse of prescriptions is the main culprit of the opioid crisis. Cannabis, the most commonly utilized illicit drug, has recently been substituted for opioid despite increasing cannabis-use emergency room visits. There is limited information on opioid-use disorders, the association with cannabis, and other contributing factors.MethodsWe analyzed the 2005 to 2014 NIS data that identified opioid-use disorders among hospitalized patients with cervical and lumbar spinal conditions and treatment using the International Classification of Disease, Ninth Revision-Clinical Modification codes for opioid abuse, dependence, poisoning, and cervical and lumbar spinal diseases and procedures. The compound annual growth rate (CAGR) was used to quantify trends of opioid-use disorders among hospitalized patients. Multilevel and multivariable regression analyses were performed to determine their contributing factors.ResultsThe number of hospitalizations with spinal conditions and treatment increased from 2005 to 2011, then decreased between 2011 and 2014 with an overall decrease in length of stay, resulting in the CAGR of -1.60% (P < .001). Almost 3% (2.93%, n = 557,423) of hospitalized patients with spinal conditions and treatment were diagnosed as opioid-use disorders and its CAGR was 6.47% (P < .0001). Opioid-use disorders were associated with cannabis-use disorders (odds ratio 1.714), substance use, mental health condition, younger age, white race, male sex, higher household income, and public insurance or uninsured.ConclusionThis study suggests that opioid-use disorders are increasing among hospitalized patients with spinal conditions and treatment and associated with several demographic, and socioeconomic factors, including cannabis-use disorders.Level of evidence3.

Project description:ImportanceAn increase in opioid prescription has been observed in the Netherlands. It is vital to understand this increase and to identify risk factors for opioid prescription to ensure that health interventions remain appropriately targeted.ObjectivesTo determine the prevalence of opioid prescriptions and adverse events associated with opioids, and to identify risk factors associated with opioid prescription in the Dutch population.Design, setting, and participantsThis cohort study used national statistics from the Netherlands from January 1, 2013, to December 31, 2017, including the full Dutch population of 16?779?575 people in 2013 and 17?081?507 people in 2017. Data from the Dutch Health Monitor surveys of 2012 and 2016 were also included. Databases were anonymized prior to analysis. All analyses were performed between December 2018 and February 2019.ExposureOpioid prescription.Main outcomes and measuresThe main outcomes were the dynamics of opioid prescriptions, hospital admissions for opioid overdose, and opioid overdose mortalities. The secondary outcome was risk factors associated with opioid prescription.ResultsIn 2013, 814?211 individuals (4.9% of the total population) received an opioid prescription. In 2017, 1?027?019 individuals (6.0% of the total population) received at least 1 opioid prescription (mean [SD] age, 59.3 [18.5] years; 613?203 [59.7%] women). The rate of hospital admissions for opioid overdose was 9.2 per 100?000 inhabitants in 2013 and 13.1 per 100?000 inhabitants in 2017 (relative risk, 1.43 [95% CI, 1.34-1.52]). Similarly, an increased risk of opioid overdose death was observed, from 0.83 per 100?000 inhabitants in 2013 to 1.2 per 100?000 inhabitants in 2017 (relative risk, 1.49 [95% CI, 1.20-1.85]). Based on data from the 2012 Dutch Health Monitor survey, risk factors associated with opioid prescription included being older than 65 years (odds ratio [OR], 4.20 [95% CI, 3.98-4.43]), having only a primary school education (OR, 3.62 [95% CI, 3.46-3.77]), being widowed (OR, 3.30 [95% CI, 3.13-3.49]), reporting always feeling symptoms of depression (OR, 3.77 [95% CI, 3.41-4.18]), and reporting poor or very poor physical health (OR, 10.40 [95% CI, 10.01-10.81]). Self-reported back pain (OR, 4.34 [95% CI, 4.23-4.46]) and rheumatoid arthritis or fibromyalgia (OR, 3.77 [95% CI, 3.65-3.90]) were also associated with opioid prescription. However, unemployment (OR, 1.05 [95% CI, 0.96-1.13]) was not associated with opioid prescription, and alcohol use disorder (OR, 0.76 [95% CI, 0.73-0.80]) was negatively associated with opioid prescription.Conclusions and relevanceThis study found that opioid prescriptions have increased in the Netherlands. Although the risk of adverse events is still relatively low, there is an urgent need to review pain management to prevent a further increase in opioid prescription.

Project description:BackgroundAddiction treatment and harm reduction services reduce risks of death and re-infection among patients with injection drug use-associated infective endocarditis (IDU-IE), but these are not offered at many hospitals. Among hospitalized patients with IDU-IE at the two tertiary-care hospitals in the Canadian Maritimes, we aimed to identify (1) the availability of opioid agonist treatment (OAT) and sterile drug injecting equipment, and (2) indicators of potential unmet addiction care needs.MethodsRetrospective review of IDU-IE hospitalizations at Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia) and the Saint John Regional Hospital (Saint John, New Brunswick), October 2015 -March 2017. In Halifax, there are no addiction medicine providers on staff; in Saint John, infectious diseases physicians also practice addiction medicine. Inclusion criteria were: (1) probable or definite IE as defined by the modified Duke criteria; and (2) injection drug use within the prior 3 months.ResultsWe identified 38 hospitalizations (21 in Halifax and 17 in Saint John), for 30 unique patients. Among patients with IDU-IE and untreated opioid use disorder, OAT was offered to 36% (5/14) of patients in Halifax and 100% (6/6) of patients in Saint John. Once it was offered, most patients at both sites initiated OAT and planned to continue it after discharge. In Halifax, no patients were offered sterile injecting equipment, and during five hospitalizations staff confiscated patients' own equipment. In Saint John, four patients were offered (and one was provided) injecting equipment in hospital, and during two hospitalizations staff confiscated patients' own equipment. Concerns regarding undertreated pain or opioid withdrawal were documented during 66% (25/38) of hospitalizations, and in-hospital illicit or non-medical drug use during 32% (12/38). Two patients at each site (11%; 4/38) had self-directed discharges against medical advice.ConclusionsPatients with IDU-IE in the Canadian Maritimes have unequal access to evidence-based addiction care depending on where they are hospitalized, which differs from the community-based standard of care. Indicators of potential unmet addiction care needs in hospital were common.

Dataset Information

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis.

Importance

Objectives

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Publications

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure